Infection risk and oral sex

Reviewed by Dr David Delvin, GP and family planning and sex specialist



Oral sex is now very common in both heterosexual and homosexual couples.

For many years it was regarded as an almost 'unmentionable' activity. But these days, research suggests that most sexually active people go in for it sometimes.

It has been shown that oral sex has certain very positive aspects.

It can be extraordinarily effective at helping women to reach a climax.

It can help men who have some minor difficulty in getting an erection.

It cannot get you pregnant (except under the most extraordinary and unlikely circumstances).

However, a lot of people do – quite understandably – worry about whether oral love play could give them any infection – particularly HIV.

In this article, we look at the risks.

What is oral sex?

First, let's just clarify what we mean by 'oral sex'. There are several main types.

Cunnilingus (sometimes referred to as 'cunnilinctus') is oral stimulation of a woman's vagina and/or vulva - and especially her clitoris - by her partner's lips and tongue (one recent study reports that in the UK about 70 per cent of people have done this).

Fellatio is stimulation of a man's penis by his partners mouth – usually by licking or sucking. It is often wrongly referred to as 'a blow job' in fact, it is highly dangerous to 'blow' during this manoeuvre (or during cunnilingus). Research indicates that just under 70 per cent of British people have tried fellatio.

'Nippling' is sucking or licking your partner's nipples. It carries almost no risk of any infection.

'Shrimping' is a practice involving sucking your partner's toes; it seems to be popular among those who find feet sexually attractive. Again, there is almost no risk of sex infection.

Oro-anal sex – often referred to as 'rimming' – is stimulation of the partner's anus with tongue or lips. Clinical experience suggests that it is relatively uncommon in heterosexuals. As the anus isn't a very clean area of the body, there is no doubt that rimming will lead to some transfer of germs to the mouth.

HIV infection risk

Because of growing concerns about the possibility of HIV transmission through the very widespread practice of oral sex, the British Government's Department of Health set up an expert group to report back on the matter. In broad summary, their main conclusions were:

HIV can be transmitted by oral sex, though this does not occur frequently.

both fellatio and cunnilingus have been known to pass it on.

both 'receiving' and 'giving' fellatio have been incriminated.

oral sex is certainly much safer HIV-wise than rectal or anal sex.

oral sex is probably safer than vaginal intercourse.

ulcers in the mouth could increase the risk.

oral sex is more risky than non-penetrative sex (eg mutual masturbation, kissing, etc).

during fellatio, if the man avoids ejaculation, it probably reduces the risk somewhat.

in the case of cunnilingus, there may be an increased risk of transmission if the woman is menstruating.

there is no evidence that mouthwashes could reduce the risk of infection.

using condoms or 'dental dams' during oral sex could reduce the chance of infection, but not eliminate it.

You can see from the above that there is always some risk of transmission of HIV during oral sex, whatever precautions you take. However, you cannot get infected if your partner does not have the virus!

What other germs could you pick up during oral sex?

As any doctor at a genitourinary medicine (GUM) clinic can tell you, it is possible to acquire several forms of venereal disease (VD) through oral sex – if the other person if infected.

Gonorrhoea Gonorrhoea, a common form of VD, can be transmitted to the throat during oral sex, especially fellatio. Because of this fact, GUM clinics often take 'throat swabs' these days. In the throat, the germ usually causes inflammation, pus formation and sometimes soreness.

Syphilis

The lesions of syphilis usually appear on the genitals or the anus – and very rarely on the nipple. But they do occasionally appear on the lips, probably as a result of oral sex.

However, please bear in mind that in the UK syphilis has been a great rarity for many years. Nevertheless, there have been one or two small outbreaks among gay males in the early 2000s, notably in Bristol and Brighton.

Chlamydia

Chlamydia trachomatis - this little genital bug has become almost epidemic among sexually active young people during the early years of the 21st century. It is sometimes found in swabs taken from the throat, and it is thought that it can be transmitted by oral sex, particularly fellatio. Please note that if it gets established in or near the mouth or nose, it could cause various infections, particularly of the eye.

Bacterial infections transferred by oro-anal sex

As we've indicated above, contact between the mouth and the anus will probably result in the transfer of 'bottom germs' – though these will not necessarily cause disease.

Bowel organisms There is evidence that the bowel organisms Salmonella, Shigella and Campylobacter can all be transmitted by oro-anal contact. These can all cause abdominal pain and diarrhoea. Infections with Salmonella and Shigella can occasionally be very serious.

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